Self-illness ambiguity refers to the uncertain relationship between an individual’s sense of self and their illness experience. This can arise in chronic health conditions, being particularly potent in long-term mental health conditions (de Haan 2023). Self-illness ambiguity can be further complicated by medications, such as SSRI’s, which can lead someone to be unsure if the person they are on an SSRI is ‘truly them’ or if the medication masks their ‘true’ self (Elliott 2003 p.51).

Existentialism is a philosophy, associated with Jean-Paul Sartre, that emphasises personal freedom and responsibility in a chaotic world (Sartre 1946). It highlights that people define themselves through their actions, arguing this should be done in a way that lets people live authentically. For existentialism, authenticity requires being true to your beliefs and values, despite external pressures to do otherwise. Here, I explore how an existentialist might make sense of self-medication ambiguity as it relates to authenticity, responsibility and freedom.

Self-medication ambiguity can disrupt someone’s sense of authenticity. Consider Alicent, an artist, prescribed an SSRI for depression. While her medication makes her feel more balanced, she wonders about its impact on her personality and creativity. Before starting medication , Alicent used her emotional experiences to fuel her artwork. SSRIs have dulled her emotions and she feels she has lost this aspect of her personality. Alicent wonders if she is truly herself while on medication.

Existentialism emphasises the importance of self-creation, since it argues we define ourselves. It encourages individuals to embrace their unique abilities and pursue their passions, such as Alicent’s creative works. One existentialist interpretation of Alicent’s situation validates her concerns surrounding losing part of her personality. Existentialism encourages individuals to preserve their authentic self by resisting external factors that may influence their identity (Sartre 1943 p817), such as her medication. If Alicent continues to take her medication despite her feeling that it is eroding her creativity she might be accused of prioritising comfort over authenticity (Sartre 1946 p.4).

However, an alternative existentialist interpretation might instead emphasise the inherent struggles and ambiguities of the human condition (Sartre 1946 p.10). This existentialist could argue that Alicent is in fact engaging with the realities of her condition, not hiding from them, because she is acknowledging her concerns, rather than ignoring them. This within itself is an act of authenticity, making this scenario more complicated, since she is acting authentically in one way, yet the medication may be hindering her authenticity in another.

Self-medication ambiguity can also disrupt someone’s sense of personal responsibility. Take Simone, who uses SSRIs for anxiety and depression. During an argument, Simone says hurtful things to her girlfriend. Simone feels this was out of character and wonders if her behaviour was due to her medication.

One existentialist interpretation would argue that these actions are Simone’s, regardless of whether they were influenced by the medication. Personal responsibility is central to Sartre’s philosophy (Sartre 1946 p.3). Sartre argues we are not separate from the context in which we live (Sartre 1943 p.816), therefore even when our actions are influenced by external factors, our actions are still our own and we hold full responsibility; we cannot escape this responsibility except through death (Webber 2009 p59).

A differing existentialist interpretation would argue that the medication may genuinely limit Simone’s agency. If true, Simone would not be wholly responsible for the outburst, as there may be genuine reasons to attribute the change to her medication, since they may not reflect her authentic self. Under this interpretation, Simone is still somewhat responsible as she did perpetrate the act, but not by an authentic act of self-creation.

Finally, self-medication ambiguity may disrupt an individual’s sense of freedom. Consider Joshua who has been taking an SSRI to treat depression for years. While the medication stabilises his mood, he struggles with the idea that his freedom has been diminished in some way. He wonders whether the medication produces his stable mood only by dampening his true experiences. This leads him to question if he is truly free to engage with the world in a meaningful way.

Joshua’s apprehensions are complicated for existentialists, since existentialism argues freedom requires embracing one’s true reality (Sartre 1946 p.12). Existentialists recognise the burden of personal freedom (Weberman 2011 p880). Joshua’s struggle with self-medication ambiguity highlights this burden; individuals have the freedom to make their own choices, and with that comes the responsibility to accept their consequences. One interpretation would argue Joshua chooses to take the medication, and by doing so Joshua is exercising his freedom in a meaningful way (self-improvement). He is responsible for the consequences, which includes the change in his experience of the world and the ambiguity it creates. Existentialism claims we have the freedom to define ourselves through our actions, and Joshua’s choice to take the medication is an act of self-creation.

Alternatively, some existentialists would argue Joshua’s use of medications do in fact limit his freedom, validating his concerns. If Joshua’s medication is indeed limiting his range of emotional experience, this may be viewed by existentialists as a legitimate hindrance to enacting his personal freedom. This is because it may genuinely limit his engagement with the world, which existentialism highly values (Sartre 1943 p.815).

Overall, this brief existentialist analysis has highlighted the complexity of issues regarding self-narrative and self-actualisation that arise from self-medication ambiguity. There are complex implications for individuals’ views of themselves, as well as moral concerns relating to one’s responsibility.

Bibliography

de Haan, S. (2023) ‘What do my problems say about me?’, Philosophical Explorations, V26:159-164

Elliott, C. (2003) Better than Well, W.W. Norton

Jeppsson, S (2022) ‘Solving the self-illness ambiguity, Philosophical investigations, 25:294-313

Russo, M. (2022) ‘From Jean-Paul Sartre to Critical Existentialism’, Sartre Studies International¸ 28:49-66

Sartre, J. (1943/2006) Being and Nothingness,Routledge

Sartre, J. (1946) Existentialism is a Humanism, Methuen Publishing,

Webber, J. (2009) The Existentialism of Jean-Paul Sartre, Routledge.

Weberman, D. (2011) ‘Sartre on the Authenticity Required if my Choices are to be Truly Mine’, , Filozofia 66(:879-889

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